Adjunctive Brexpiprazole for Patient Life Engagement in Major Depressive Disorder: A Canadian, Phase 4, Open-Label, Interventional Study: Brexpiprazole d'appoint pour l'engagement dans la vie des patients souffrant de trouble dépressif majeur: une étude interventionnelle canadienne ouverte de phase 4.

OBJECTIVES: To characterize the effects of adjunctive brexpiprazole on patient life engagement and depressive symptoms in patients with major depressive disorder (MDD) using patient-reported outcomes. METHODS: An 8-week, Phase 4, open-label, interventional study was conducted at 15 Canadian trial sites between April 2021 and May 2022. Adult outpatients with MDD (at least moderately severe) and inadequate response to 1-2 antidepressants continued their current antidepressant and received oral adjunctive brexpiprazole 0.5-2 mg/day. Co-primary endpoints were change from baseline to Week 8 in Inventory of Depressive Symptomatology Self-Report (IDS-SR) 10-item Life Engagement subscale score, and IDS-SR 30-item total score. Safety was assessed by standard variables. RESULTS: Of 122 enrolled patients, 120 (98.4%) were treated (mean [SD] dose: 1.2 [0.4] mg/day) and analyzed, and 111 (91.0%) completed the study. Statistically significant least squares mean improvements to Week 8 were observed on IDS-SR10 Life Engagement subscale score (baseline mean [SD]: 16.1 [4.7]; change [95% confidence interval]: -8.11 [-9.34, -6.88]; p < 0.001) and IDS-SR total score (baseline mean [SD]: 41.3 [9.8]; change [95% confidence interval]: -17.38 [-20.08, -14.68]; p < 0.001). Improvements were observed from Week 2, onwards. Treatment-emergent adverse events with incidence ≥5% were fatigue (n = 13, 10.8%), headache (n = 13, 10.8%), insomnia (n = 12, 10.0%), nausea (n = 9, 7.5%), tremor (n = 8, 6.7%), and weight increase (n = 7, 5.8%). Six patients (5.0%) discontinued due to adverse events. Mean (SD) change in body weight from baseline to last visit was +1.9 (3.4) kg. CONCLUSIONS: Using an exploratory patient-reported outcome measure, patients with MDD and inadequate response to antidepressants who received open-label adjunctive brexpiprazole showed early and clinically meaningful improvement in patient life engagement, which should be further assessed in a prospective randomized controlled trial. Patient-rated depressive symptoms (on the validated 30-item IDS-SR) also improved. Adjunctive brexpiprazole was well tolerated, and no new safety signals were observed. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04830215.

Impact of pectus excavatum on pulmonary function and exercise capacity in patients treated with 3D custom-made silicone implants.

BACKGROUND: Pectus excavatum (PE) is the most common congenital chest wall deformity, whose cardiopulmonary consequences are controversial. PE surgery is in our experience usually performed for aesthetic reasons. OBJECTIVES: The aim of this study was to evaluate the impact of PE on respiratory function and exercise capacity in patients with PE before patient-specific silicone implant correction. METHODS: This monocentric prospective study conducted at Toulouse University Hospital included sixty patients scheduled for custom-made silicone implants correction. Respiratory function (pulmonary function tests (FPTs)) and exercise capacity (VO2 max) were measured before surgery. RESULTS: Before surgery, no (0/60) restrictive lung disease was detected, with a mean total lung capacity (TLC) of 98.5% of predicted value (IC 95%; 80.4-137). Median VO2 max (n=56) was normal (89% predicted), with no cardiac limitation. CONCLUSION: In this cohort, PE had no impact on respiratory function nor exercise capacity. In patients without cardiac or respiratory effects of PE, silicone implants should be considered the preferred approach as it adequately addressed patients' main complaint of low self-esteem.

[Setting up a training program in a geriatric short-stay department]. / Mise en place d'un programme de formations au sein d'un service de court séjour gériatrique.

As the department's team had been renewed in less than two years, it was necessary to invent a method to improve cohesion and communication, and to enhance the skills of professionals. This led to the creation of a training program using a variety of methods (theoretical training, care approaches and quality coffees).

[Improving the experience of racialized immigrant seniors in Quebec]. / Améliorer l'expérience des personnes âgées immigrantes racialisées au Québec.

In Quebec, racialized immigrant seniors (AIRs) are a significant presence in long-term care facilities (CHSLDs) in the Greater Montreal area. To identify interventions that best meet their needs, this study interviewed 12 RIAs, including their families, about their experience in CHSLDs. The results show that RIAs face three challenges: food, clothing and play. Addressing these issues could improve their LTRCC experience.

[The benefits of physical activity in the workplace for maintaining employee health]. / Intérêts de l'activité physique au travail pour le maintien de la santé des salariés.

Some jobs, particularly in the service sector, involve little physical activity on the part of employees. To improve their health, several areas or periods could be used to increase the amount of daily physical activity. Active transport to and from work is one such initiative, but physical activity can also be envisaged outside and during working hours. The aim of this article is to provide insights and research perspectives to better measure the importance of physical activity in the workplace.

[Reconciling pregnancy and business continuity at the Roubaix hospital center]. / Concilier la grossesse et le maintien de l'activité au sein du centre hospitalier de Roubaix.

This project is a way of improving the quality of working life for female professionals during their pregnancy, with shared benefits for the agent and the team. But it's also a lever of attractiveness for caregivers and a guarantee of quality for users.

Association of health literacy with physical and mental health in people with chronic diseases.

OBJECTIVE: to explore the association of health literacy domains with physical and mental quality of life in people with selected chronic diseases. METHODS: Community-dwelling people with selected chronic diseases planned for immunization against influenza in 2017/2018 were included in the study. All non-vaccinated people and the corresponding number of randomly selected vaccinated people matched on town of residence were included. Data were collected by means of socio-demographic questionnaire, Health Literacy Questionnaire (HLQ) and Short Form-36 (SF-36). The Physical and Mental Composite Scores as well as their domains were observed as the study outcomes. RESULTS: A total of 295 people were studied. The adjusted logistic regression showed that Physical and Mental composite scores were associated with all HLQ domains except 5) Appraisal of health information. Better Physical Functioning was associated with higher scores on 1) Feeling understood and supported by healthcare providers, 6) Ability to actively engage with healthcare providers, 7) Navigating the healthcare system and 8) Ability to find good health information. Better scores on Vitality, Social Functioning, Role Emotional and Mental Health were associated with higher scores on all HLQ domains except 5) Appraisal of health information. CONCLUSION: Health literacy is important for physical and mental quality of life among people with chronic diseases. Health care providers and other stakeholders should continuously work to improve health literacy of their patients.

[Déterminants de la qualité de vie liée à la santé chez les adolescents : le rôle de la diète méditerranéenne]. / Determinants of health-related quality of life among adolescents: The role of the Mediterranean diet.

BACKGROUND: A number of physical, emotional, cognitive and psychological changes shape the adolescence phase, which may influence health and well-being. Therefore, it is important to develop healthy eating habits that will persist into adulthood. OBJECTIVE: This study was conducted in order to investigate in depth the association between components of the Mediterranean diet (MD) and health-related quality of life (HRQoL), along with its different subscales, among Lebanese adolescent students attending schools in Tripoli, North Lebanon. METHODS: A cross-sectional survey was undertaken among 798 teenagers aged 11 to 18. All responded to a questionnaire that evaluated their HRQoL, sociodemographic characteristics and adherence to the Mediterranean diet. RESULTS: The results of the study revealed that only 15.9% of the students had a high adherence to the MD. With regard to the components of the MD associated with the HRQoL, it was revealed that fruit intake by the students (once daily) was associated with a better general well-being (P = 0.047). In addition, fish consumption (two to three times per week) and daily intake of a dairy product for breakfast were positively associated with the total KIDSCREEN score (P < 0.001 and P = 0.003, respectively). Finally, skipping breakfast was correlated with a poorer general well-being (P = 0.013). CONCLUSION: Our results suggest a strong correlation between MD adherence and HRQoL in Lebanese adolescents. However, future studies are warranted in order to strengthen the evidence of this association.

[Predictive factors for the level of knowledge, attitudes and quality of life of Tunisian diabetics : 1007 cases]. / Facteurs prédictifs du niveau des connaissances, des attitudes et de la qualité de vie des diabétiques tunisiens ­ À propos de 1007 cas.

AIM OF THE STUDY: To study the predictors of knowledge level, attitudes and quality of life of type 1(T1D) and type 2 (T2D) Tunisian diabetics POPULATION AND METHODS: We undertook an analytical cross-sectional study. The questionnaire was administered in Arabic and contained a section collecting socio-demographic, clinical and diabetes-specific data. The following sections contained the Arabic-translated and validated versions of the "Simplified Diabetes Knowledge Scale", the "Diabetes Attitude Scale-3" and the "Diabetes Health Profile-18" to assess level of diabetes knowledge, attitudes towards the disease and diabetics' quality of life. RESULTS: We collected 186 T1D (18.5%) and 821 T2D (81.5%) completed questionnaires. A good level of knowledge about diabetes was indicated in T1D patients by glycemic self-monitoring and by secondary and university education, urban housing, stable employment, insulin therapy and prior therapeutic education, while regular medical follow-up was of particular importance in T2DM patients. Smoking and diabetes complications were predictors of a negative attitude towards the disease in T1D and T2D respectively. Diabetics' Impaired quality of life was predicted by age < 40 years and a low level of knowledge about diabetes in T1D and by female sex, insulin therapy and a low level of knowledge about diabetes in T2D. CONCLUSION: Predictors of the level of knowledge, attitudes and quality of life of diabetics may be a basis for establishing a therapeutic education program tailored to the different populations.

The psychopathological repercussions on patients faced with pain: A focus on endometriosis.

OBJECTIVES: Endometriosis is a chronic and progressive gynecological disease that affects 1 to 2 out of 10 women of childbearing age in France. The objective of this research was to understand the factors determining the quality of life of the patients who experience significant pain symptoms (75%), distinguished by the extent and depth of the lesions. The second objective was to evaluate the psychological repercussions of this pain. We will therefore assess the various psychological processes involved in explaining quality of life. METHOD: In total, 1039 women aged 18-55 years completed a self-administered questionnaire, assessing different types of pain and intensity, body image (BIS), self-esteem (Rosenberg), anxiety-depressive symptomatology (HAD), and quality of life (SF-36). Socio-biographical and medical characteristics of the patients were also assessed. RESULTS: Analyses of variance showed that patients with chronic pain had lower self-esteem and body image, more anxiety-depressive symptoms, and a poorer quality of life than women with cyclic pain and those without pain. Regression analyses showed that the determinants of physical and mental quality of life differed significantly according to the type of pain experienced. CONCLUSION: The consequences of the pain associated with endometriosis reveal multiple problems that can be considered from a new perspective. Although psychological disorders can be a response to pain phenomena they can also contribute to their increase. This is where the challenge lies in providing comprehensive care.

Effect of human-animal interaction on the well-being and quality of life.

BACKGROUND: COVID-19, the economic and the political crises happening in Lebanon, have enforced social distancing and isolation, causing severe psychological states. However, these psychological consequences have highlighted the aim behind the interactions between humans and animals. In this study, we aimed to investigate the interaction between humans and animals and to compare the well-being and quality of life of the Lebanese pet owners in Lebanon in the face of stressors currently experienced and animals' companionship. METHODS: An observational cross-sectional retrospective design was involved in this study. The study enrolling 314 participants via an online survey was conducted between March 2021 and May 2021. The questionnaire used was pre-tested and participants were given the choice of not participating. Participants were Lebanese and over the age of 18; they responded to questions regarding their interactions with animals and the impact of different stressors on their mental and physical state. RESULTS: The study's findings indicate that most participants perceived their animals as a valuable source of support, and there was a significant correlation between the strength of the bond with their companion animals (as measured by the Comfort from Companion Animal Scale (CCAS) (R=0.14, P=0.009)) and their well-being. Additionally, the study revealed that individuals who had a closer relationship with their pets engaged in more physical activity, socialized more through social media during the pandemic period, and maintained better relationships with their parents and other relatives. However, the results showed no significant correlation between individuals' quality of life and their interaction with animals (R=0.10, P=0.07). CONCLUSION: The positive impact of human-animal interaction on human well-being has been observed in Lebanon under various stressors. This impact is closely related to the strength of the bond between humans and their animals. During the pandemic period, having a companion animal was found to promote human well-being by encouraging physical activity and social interaction. It is noteworthy that emotional and psychological health was not affected by the number of animals an individual owned. However, the recent COVID-19, political, and socio-economic crises in Lebanon have raised serious concerns regarding the psychological state of its citizens. Thus, further research is needed to address the issues highlighted in this study.

[Complications and quality of life after bodylift: About 143 patients]. / Complications et qualité de vie après bodylift inférieur : à propos de 143 patients.

INTRODUCTION: The rise of bariatric surgery has led to a considerable increase in the demand for weight loss surgery. The lower body lift consists of removing the residual abdominal fat and skin excess and re-tensioning the surfaces. The objective of our study was to evaluate the associated complications, as well as the consequences of this surgery on the quality of life of the patients. MATERIALS AND METHODS: A retrospective monocentric study was conducted in patients operated on for lower body lift between 2010 and 2019 at the University Hospital of Besançon. We collected postoperative complications and studied the satisfaction and quality of life of the operated patients using the Body-QoL and SF-36 questionnaires. RESULTS: One hundred forty-three patients were included with a mean age of 41.2 years. The mean body mass index was 26.6kg/m2 with a mean weight of 73.8kg and a mean weight loss of 54.4kg. Forty-one patients (29.7%) had at least one complication. Most complications were minor, with 16.8% of scar disunions, and 7% of complications were major, requiring revision surgery. Ninety-three patients (65%) responded to the satisfaction questionnaires with improvement mostly in physical symptoms and social life. CONCLUSION: The lower body lift is an effective, safe procedure with mostly minor complications that do not influence quality of life. Patient satisfaction is high, and it is therefore justified to continue offering this procedure to correct the sequelae of massive weight loss.

[Satisfaction and quality of life after DIEP-flap breast reconstruction]. / Satisfaction et qualité de vie après reconstruction mammaire par lambeau de DIEP.

Satisfaction and quality of life of patients who have undergone DIEP-flap breast reconstruction have been assessed by many authors in many countries using standardized tools. However, some simple and practical information is often not found in these studies. The aim of our work was to carry out a practical satisfaction survey of patients reconstructed by DIEP flap in our center. Our cohort was made up of 207 patients who underwent DIEP-flap breast reconstruction in Marseille between January 2014 and December 2020. A letter containing our original satisfaction survey was sent to all the patients in our sample. We received 104 responses, which were statistically analyzed using the flat sorting method. Nine-two percent of patients were globally satisfied with the result of their breast reconstruction. A large majority of patients are in favor of the idea of performing their reconstruction again using a DIEP flap. Fifty-five percent of participants were "not bothered at all" by their abdomen after their surgery. The DIEP flap is a versatile technique that allows surgeons to offer it in multiple breast reconstruction situations and to obtain a high degree of patient satisfaction.

Measurement of quality of life in orthognathic surgery using an original questionnaire: About a series of 123 cases.

INTRODUCTION: The aim of this study was to measure changes in the quality of life of patients who had orthognathic surgery using an original questionnaire, designed for this purpose. MATERIAL AND METHOD: This single-center retrospective study included all patients who had orthognathic surgery in our center between 2014 and 2019. An original questionnaire comprising 13 items in 4 domains was sent to patients postoperatively by email after telephone contact and obtaining their consent. Items were scored on a 5-point scale ranging from (-1), worse than before surgery, to (+3), better than before surgery. RESULTS: All data were collected in a standardized way. In total, 123 patients responded. The mean score for all surgeries combined was +1.14, indicating an improvement in QOL considered to be "low to moderate". A total of 118 patients (95.9%) reported an improvement following surgery, including 18 patients (14.6%) who reported a marked improvement. The greatest improvement was observed for psychosocial aspects and morphology. CONCLUSION: This study shows a positive effect of orthognathic surgery on patients' QOL, including self-perception, relationships with others, or functional aspects as mastication and breathing. We propose an original tool that is easy to use by patients to measure quality of life following orthognathic surgery.

[Morbidity and quality of life following breast reconstruction by autologous latissimus dorsi, muscle sparing and perforator flaps]. / Morbidité et qualité de vie après reconstruction mammaire par lambeau de grand dorsal autologue, à épargne musculaire et perforant.

INTRODUCTION: Morbidity following autologous latissimus dorsi flap (ALD), muscle sparing latissimus dorsi flap (MSLD) and thoracodorsal artery perforator flap (TAP) is controversial. The purpose of this study was to measure morbity using Quick Dash at 1 month and 1 year following breast reconstruction with one of these three flaps. The second objective was the evaluation of quality of life using Breast-Q. PATIENTS AND METHOD: Thirty four consecutive patients who had undergone breast reconstruction were included in this monocentric and prospective study: 10 patients in the ALD group, 12 patients in the MSLD group and 12 patients in the TAP group. RESULTS: At 1 month and 1 year following surgery, the variation of Quick Dash was 13,63 and 2,38 in the ALD group, 3,41 and -1,13 in the MSLD group and 5,69 and 0 in the TAP group. Satisfaction whith breasts, psychosocial, sexual and chest well-being were higher in the ALD group. Satisfaction with back was higher in the MSLD and TAP groups. Back and shoulder well-being was comparable regardless of the flap. Seroma occurrence was very rare in case of TAP, rare and not abundant in case of MSLD and frequent in case of ALD. CONCLUSION: This study appears to confirm that immediate morbidity is less important with MSLD or TAP than ALD. Hoewever at one year following surgery, morbity seems to be comparable with the 3 flaps. Patients satisfaction seems to be higher with ALD except for the aspect of the back.

Evaluation of satisfaction and the quality of life after bilateral breast reconstruction using the BREAST-Q questionnaire.

BACKGROUND: The demand of breast reconstruction is growing, the purpose of this study is to evaluate the satisfaction and quality of life of patients who underwent bilateral breast reconstruction. METHODS: In this cohort retrospective study, patients who underwent bilateral breast reconstruction in our department between September 2009 and December 2019 were asked to complete BREAST-Q questionnaire based on the timing of the reconstruction received following mastectomy, thus dividing them into three groups: (1) bilateral immediate breast reconstruction(BIBR), (2) immediate breast reconstruction in one side and delayed reconstruction on the other side (mixed group), (3) bilateral delayed breast reconstruction(BDBR). Surgical techniques were divided into prosthesthetic (permanent implant and expander), flaps (pedicle or free), mixed technique (associating flap and prosthesis). RESULTS: Seventy-one out of 94 patients responded to our BREAST-Q questionnaire, with a response rate of 84.5%. A high score is associated with a better result, except in physical well-being where a lower score indicates better outcome. The average score for psychosocial well-being is 63.0 (±17.2) achieving the lowest among the BDBR group. Physical well-being score is 26.0 (±18.6) scoring the highest in BIBR group. Sexual well-being score is 52.2 (±17.4) and seen highest among BDBR group. Satisfaction with breast score is 54.1 (±10.0) and was highest among mixed group. CONCLUSION: The therapeutic proposal was personalized based on patient profile and choice. The best reconstruction treatment enhancing the quality of life and patient satisfaction remains the option chosen by the patient and whose advantages and disadvantages are accepted by them.

[Assessment of the risk of occurrence of musculoskeletal disorders in a production unit]. / État des lieux du risque de survenue de troubles musculosquelettiques dans une unité de production.

INTRODUCTION: In 2018, according to the latest report from the French National Cancer Institute (INCa), approximately 400,000 new cases of cancer in France were identified. Fifty-four percent were represented by men and 46% by women. The number of new cases increased between 2010 and 2018 (+6,000 cases for men and 23,000 for women). Hospital pharmacies caring for cancer patients must absorb this flow without having additional human resources or without being able to increase the capacity of the chemotherapy reconstitution unit. And this always while ensuring a quality according to the legal requirements. This increase of activity and the centralization of chemotherapy preparations bring with it new problems: musculoskeletal disorders (MSDs). The objective of this work is, through the improvement of work quality, to prevent and monitor the appearance of MSDs in pharmacy technician team. METHOD: Initially, using the Nordic questionnaire, an inventory of the pain and genes felt by the staff according to location and duration was conducted with pharmacy technician team. Secondly, an assessment of the risk of occurrence of MSDs in the pharmacy technician team according to the tasks performed was carried out using the Borg CR10 scale and the Occupational Safety and Health Administration (OSHA) checklist. RESULTS/DISCUSSION: The prevalence of musculoskeletal complaints over the last twelve months and the last seven days within the sample was highest for the wrists/hands (67% and 56%) and head/neck (56% and 33%). The severity index of musculoskeletal problems at work was 50% for the elbow region and 33% for the wrist/hand region. According to the OSHA checklist, the workstations for the preparation of cytotoxics and the workstations for the preparation of analgesics intended for the intrathecal route obtained a score greater than 5, which is equivalent to a risk of occurrence of MSDs. On the positions evaluated using Borg's CR10 scale, the following body regions saw a significant increase in the strain felt after a day of production: head/neck (P-value 0.04), upper back (P-value 0.03), lower back (P-value 0.03) and legs (0.04). CONCLUSION: This work made it possible to produce a map of the body regions affected, to identify the positions at risk and to assess the level of risk. Several approaches have been defined to prevent MSDs for the pharmacy technician team. Staff training, by one of the physiotherapists, in muscle warm-ups before a production day is planned. In the continuity of this approach, an expertise by an ergonomist, which could not be carried out due to the health situation and the preventive measures would be essential in order to put in place additional preventive and curative actions.

A new tool to investigate anorectal disorders in patients with multiple sclerosis: STAR-Q.

BACKGROUND: Bowel symptoms are commonly experienced by patients with Multiple sclerosis (PwMS), but no specific questionnaire validated in this population allows a rigorous assessment. OBJECTIVE: Validation of a multidimensional questionnaire assessing bowel disorders in PwMS. METHODS: A prospective, multicenter study was conducted between April 2020 and April 2021. The STAR-Q (Symptoms' assessmenT of AnoRectal dysfunction Questionnaire), was built in 3 steps. First, literature review and qualitative interviews were performed to create the first version, discussed with a panel of experts. Then, a pilot study assessed comprehension, acceptation and pertinence of items. Finally, the validation study was designed to measure content validity, internal consistency reliability (alpha coefficient of Cronbach) and test-retest reliability [intraclass correlation coefficient (ICC)]. The primary outcome was good psychometric properties with Cronbach's α>0.7 and ICC>0.7. RESULTS: We included 231 PwMS. Comprehension, acceptation and pertinence were good. STAR-Q showed a very good internal consistency reliability (Cronbach's α=0.84) and test-retest reliability (ICC=0.89). Final version of STAR-Q was composed of 3 domains corresponding in symptoms (Q1-Q14), treatment and constraints (Q15-Q18) and impact on quality of life (Q19). Three categories of severity were determined (STAR-Q≤16: minor, between 17 and 20: moderate, and≥21: severe). CONCLUSIONS: STAR-Q presents very good psychometric properties and allows a multidimensional assessment of bowel disorders in PwMS.

[Guidelines on the urological management of the adult patient with spinal dysraphism (spina bifida)]. / Recommandations sur la gestion du risque et la prise en charge urologique du patient adulte atteint de dysraphisme spinal (spina bifida).

INTRODUCTION: Improved life expectancy and prenatal screening have changed the demographics of spina bifida (spinal dysraphism) which has presently become a disease of adulthood. Urinary disorders affect almost all patients with spinal dysraphism and are still the leading cause of mortality in these patients. The aim of this work was to establish recommendations for urological management that take into account the specificities of the spina bifida population. MATERIALS AND METHODS: National Diagnosis and Management Guidelines (PNDS) were drafted within the framework of the French Rare Diseases Plan at the initiative of the Centre de Référence Maladies Rares Spina Bifida - Dysraphismes of Rennes University Hospital. It is a collaborative work involving experts from different specialties, mainly urologists and rehabilitation physicians. We conducted a systematic search of the literature in French and English in the various fields covered by these recommendations in the MEDLINE database. In accordance with the methodology recommended by the authorities (Guide_methodologique_pnds.pdf, 2006), proposed recommendations were drafted on the basis of this literature review and then submitted to a review group until a consensus was reached. RESULTS: Bladder dysfunctions induced by spinal dysraphism are multiple and varied and evolve over time. Management must be individually adapted and take into account all the patient's problems, and is therefore necessarily multi-disciplinary. Self-catheterisation is the appropriate micturition method for more than half of the patients and must sometimes be combined with treatments aimed at suppressing any neurogenic detrusor overactivity (NDO) or compliance alteration (anticholinergics, intra-detrusor botulinum toxin). Resort to surgery is sometimes necessary either after failure of non-invasive treatments (e.g. bladder augmentation in case of NDO resistant to pharmacological treatment), or as a first line treatment in the absence of other non-invasive alternatives (e.g. aponeurotic suburethral tape or artificial urinary sphincter for sphincter insufficiency; urinary diversion by ileal conduit if self-catheterisation is impossible). CONCLUSION: Spinal dysraphism is a complex pathology with multiple neurological, orthopedic, gastrointestinal and urological involvement. The management of bladder and bowel dysfunctions must continue throughout the life of these patients and must be integrated into a multidisciplinary context.

Quality of life of patients treated for kidney stones 10-20mm in diameter in terms of the type of operation performed: A qualitative study.

INTRODUCTION: Urolithiasis is a common chronic disease whose effect on patients' quality of life (QOL) is considerable but depends on the treatment received, differing between types of surgery. Intrarenal stones can be treated with different techniques: extracorporeal shock wave lithotripsy (ESWL), flexible ureteroscopy (fURS), and mini percutaneous nephrolithotomy (mini-PCNL), with proportional success and complication rates. The aim of this study was to qualitatively explore the impact of the different techniques on patients' QOL and understand their experiences of treatment choices. METHODS: Patients treated for medium-sized kidney stones (10-20mm in diameter) were interviewed in a semi-structured manner. The interview data were transcribed and analyzed by theme according to consolidated criteria for reporting qualitative research (COREQ) guidelines. RESULTS: Data saturation was achieved after interviewing 15 patients. The mean interview time was 34min (standard deviation (SD), 6.8min). The mean patient age was 54 years (SD, 9.5 years). Eight patients underwent ESWL, 10 were treated with fURS, and 8 underwent mini-PCNL. Twenty-seven subthemes were coded and regrouped into eight major themes, namely: no sense of choice in the decision-making process for eleven patients; extremely negative experiences of double-J stents for fourteen patients; concern about the risk of recurrence or treatment failure for thirteen patients; complicated hygiene and dietary recommendations for nine patients; technique-dependent postoperative outcomes; relatively well-tolerated operations for thirteen patients; a poor experience of sick leave, often because of a double-J stent; different views regarding future operations. In fact, a third of patients would choose the most effective treatment, a third would choose the simplest procedure and the last third would trust their urologist. Patients' experiences of these operations are variable. CONCLUSION: Urologists must support their patients by presenting the different treatment options with clear, appropriate, and unbiased information. This should ensure patients take part in treatment decisions as part of a personalized treatment plan.